Eating Disorders and Comorbidity with Depression and Anxiety

Posted in Dual Diagnosis on October 2, 2012
Last modified on April 24th, 2019

Eating disorders can be characterized into three main types: anorexia, bulimia, and binge eating disorder. The characteristics of each disorder differ, but one fact remains: people who suffer from eating disorders have a higher likelihood of suffering from anxiety and depression than those who do not suffer from eating disorders. In fact, up to 80 percent of those with anorexia have suffered major depression at some point, and as many as 80 percent of bulimics have suffered from an anxiety disorder. There are several theories as to why this might happen.

Eating disorders are most likely to afflict young women. Only 5 to 15 percent of sufferers are male. Up to 3 percent of American women will suffer from anorexia in their lifetimes, and up to 4 percent of women will suffer from bulimia. The vast majority (approximately 90 percent) of people who suffer from an eating disorder are between the ages of twelve and twenty-five.

Determining Its Origins Can Be Problematic

It is difficult to determine which comes first – the eating disorder, or the anxiety or depression. What is clear is that low self-esteem and lack of a feeling of control are common traits of the eating disordered patient. Feelings of inadequacy, anger, or loneliness are also possible factors, according to nationaleatingdisorders.org. Others may suffer from troubled personal relationships, physical or sexual abuse, or ongoing body image issues. Some are quick to blame the media for plastering images of too-thin women all over magazines, television, and other forms of media.

Scientists have found that high levels of cortisol and vasopressin are evident in both anorexic patients and people who suffer from depression. These two hormones are released as a response to stress. Too much of the stress hormone in the body is harmful on the immune system and various organs – including the brain.

Two neurotransmitters may also be responsible for the seemingly inseparable link between mood disorders and eating disorders. Serotonin and norepinephrine work to regulate certain functions in the mind and body including appetite, emotions, and sleep. When these regulatory systems are not working properly, the brain cannot communicate messages to the body effectively. This can result in mood disorders and abnormal appetite regulation.

Even if anxiety and depression precede the eating disorder, these mental health concerns certainly do not go away after years of disordered eating. Inadequate nutrition due to self-starvation or purging can cause the shutdown of several functions within the body. Low levels of tryptophan, for example, leads to mood problems.

Electrolyte depletion, vitamin deficiencies, malnutrition, and dehydration all come with a host of further – and sometimes lasting- problems. Women and men who have engaged in fasting or self-induced vomiting and endured rapid weight loss tend to experience higher levels of anxiety of depression later in life. Anorexic patients are more likely to abuse alcohol and drugs. About one-fifth of anorexic patients attempt suicide. Brain scans of anorexic patients show that the abnormal brain activity that shows during anorexic states can remain long after symptoms have disappeared.

Treatment Approaches

Since mood and eating disorders so often go hand in hand, the treatment approach must take into consideration the type of eating disorder and the prevalence of a mood disorder. It would not make sense, for example, to put an eating disordered patient on a nutritional plan designed to put weight on if the underlying anxiety is not treated as well.

Treatment for bulimia or binge eating disorder will usually include anti-depressant medication and cognitive therapy. Cognitive therapy teaches the sufferer to recognize what triggers cause binges. They will learn more positive methods of coping with stress, such as talking, practicing yoga, exercising or meditating. Bulimics and binge eaters alike often find benefit in taking part in group therapy and psychodynamic therapy to discuss their self-esteem issues.

Advanced stages of anorexia require hospitalization to restore nourishment to the body. Since anorexics have extreme body image issues, they also benefit from cognitive behavioral therapy to work on healthy methods of coping with stress. Younger anorexic patients can benefit from family therapy, so the entire family can work as a unit to recognize symptoms of relapse and encourage healthy eating habits. Anti-depressants are not recommended for anorexics, as many of them suppress appetite.

For eating disorder patients, recovery may be a life-long struggle. Sufferers must be monitored for symptoms of anxiety and depression, as mood disorders left untreated can cause the disordered eating to recur. Treatment is a lifelong process.

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